{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:17:44Z","timestamp":1778084264977,"version":"3.51.4"},"reference-count":44,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Nodding Syndrome (NS) is a debilitating neurodegenerative disease plaguing children in sub-Saharan Africa, with the highest prevalence in northern Uganda and South Sudan. The disease is characterized by head nodding, seizures, cognitive impairment, and physical wasting. Despite decades of research, the exact etiology of NS remains unclear. Some evidence suggests a link to\n                    <jats:italic>Onchocerca volvulus<\/jats:italic>\n                    infection, vitamin deficiency, and war-related displacement. Although the etiology remains unclear, effective treatment has been demonstrated with a combination of anticonvulsants, nutritional supplementation, and psychological\/social therapy. Comprehensive care has been shown to slow disease progression and even reverse symptoms in some patients. NS presents complex challenges beyond its clinical scope, including stigma, caregiver burden, and political mistrust. Though researching the exact etiology of NS shall continue, sufficient resources should be allocated to implement multidisciplinary care programs and prioritize symptomatic treatment to improve the lives of children and families affected by this devastating condition.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0692","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T18:10:49Z","timestamp":1774375849000},"page":"814-818","source":"Crossref","is-referenced-by-count":0,"title":["Nodding Syndrome: Shifting the Focus from Cause to Treatment"],"prefix":"10.4269","volume":"114","author":[{"given":"Matthew D.","family":"Myers","sequence":"first","affiliation":[{"name":"Charles E. Cheever Jr. Center for Medical Humanities & Ethics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Torie P.","family":"Hagin","sequence":"additional","affiliation":[{"name":"Charles E. Cheever Jr. Center for Medical Humanities & Ethics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjana","family":"Ramchandran","sequence":"additional","affiliation":[{"name":"Charles E. Cheever Jr. Center for Medical Humanities & Ethics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sally M.","family":"Yan","sequence":"additional","affiliation":[{"name":"Charles E. Cheever Jr. Center for Medical Humanities & Ethics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riya N.","family":"Soni","sequence":"additional","affiliation":[{"name":"Charles E. Cheever Jr. Center for Medical Humanities & Ethics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Latim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Gulu University, Gulu, Uganda;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilam J.","family":"Soni","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Diseases and Critical Care Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA;"},{"name":"Division of Hospital Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA;"},{"name":"Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"eNeurologicalSci","first-page":"100401","article-title":"Nodding syndrome: A key role for sources of nutrition?","volume":"27","author":"Spencer","year":"2022"},{"key":"b2","series-title":"Trop Med Infect Dis","first-page":"211","article-title":"Nodding syndrome: A scoping review","volume":"6","author":"Abd-Elfarag","year":"2021"},{"key":"b3","series-title":"Int J Infect Dis","first-page":"112","article-title":"Is nodding syndrome an Onchocerca volvulus-induced neuroinflammatory disorder? Uganda\u2019s story of research in understanding the disease","volume":"45","author":"Idro","year":"2016"},{"key":"b4","series-title":"Lancet Neurol","first-page":"30","article-title":"Uganda: How goes the nodding syndrome war?","volume":"15","author":"Burton","year":"2016"},{"key":"b5","series-title":"Pathogens","first-page":"190","article-title":"Nodding Syndrome: Clinical characteristics, risks factors, access to treatment, and perceptions in the Greater Mundri Area, South Sudan","volume":"12","author":"Abd-Elfarag","year":"2023"},{"key":"b6","series-title":"Afr Health Sci","first-page":"219","article-title":"Proposed guidelines for the management of nodding syndrome","volume":"13","author":"Idro","year":"2013"},{"key":"b7","series-title":"Lancet Glob Health","first-page":"e1260","article-title":"Effect of onchocerciasis elimination measures on the incidence of epilepsy in Maridi, South Sudan: A 3-year longitudinal, prospective, population-based study","volume":"11","author":"Jada","year":"2023"},{"key":"b8","article-title":"Statement on Nodding Syndrome in Northern Uganda","author":"Aceng","year":"2018"},{"key":"b9","series-title":"Biochem Biophys Rep","first-page":"101498","article-title":"Nodding syndrome is unlikely to be an autoimmune reaction to leiomodin-1 after infection by Onchocerca volvulus","volume":"35","author":"Kodja","year":"2023"},{"key":"b10","series-title":"Nat Microbiol","first-page":"2488","article-title":"Diverse RNA viruses of parasitic nematodes can elicit antibody responses in vertebrate hosts","volume":"9","author":"Quek","year":"2024"},{"key":"b11","series-title":"Open Forum Infect Dis","first-page":"ofaa206","article-title":"A second population-based cohort study in Cameroon confirms the temporal relationship between onchocerciasis and epilepsy","volume":"7","author":"Chesnais","year":"2020"},{"key":"b12","series-title":"PLoS Negl Trop Dis","first-page":"e0008965","article-title":"Onchocerca volvulus and epilepsy: A comprehensive review using the Bradford Hill criteria for causation","volume":"15","author":"Colebunders","year":"2021"},{"key":"b13","series-title":"Trends Parasitol","first-page":"126","article-title":"Onchocerciasis-associated epilepsy: An update and future perspectives","volume":"39","author":"Hadermann","year":"2023"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0012971","article-title":"Investigating HLA haplotypes as a potential risk factor for nodding syndrome: A case-control study in the Mahenge area, Tanzania","volume":"19","author":"Hadermann","year":"2025"},{"key":"b15","series-title":"Brain","first-page":"968","article-title":"Genomic analysis, immunomodulation and deep phenotyping of patients with nodding syndrome","volume":"146","author":"Soldatos","year":"2023"},{"key":"b16","series-title":"Pathogens","first-page":"116","article-title":"Neuropathological changes in Nakalanga Syndrome \u2013 A case report","volume":"10","author":"Hotterbeekx","year":"2021"},{"key":"b17","series-title":"Lancet Glob Health","first-page":"e1149","article-title":"Doxycycline for the treatment of nodding syndrome: A randomised, placebo-controlled, phase 2 trial","volume":"12","author":"Idro","year":"2024"},{"key":"b18","series-title":"Clin Infect Dis","first-page":"1199","article-title":"Therapeutic efficacy and macrofilaricidal activity of doxycycline for the treatment of river blindness","volume":"60","author":"Walker","year":"2015"},{"key":"b19","article-title":"Nodding Syndrome: A Devastating Illness.","year":"2012"},{"key":"b20","series-title":"Pan Afr Med J","first-page":"228","article-title":"Treatment and rehabilitation outcomes of children affected with nodding syndrome in northern Uganda: A descriptive case series","volume":"29","author":"Gazda","year":"2018"},{"key":"b21","series-title":"PLoS Negl Trop Dis","first-page":"e0007344","article-title":"\u201cThose who died are the ones that are cured.\" Walking the political tightrope of Nodding Syndrome in northern Uganda: Emerging challenges for research and policy","volume":"13","author":"Irani","year":"2019"},{"key":"b22","series-title":"PLoS One","first-page":"e0238643","article-title":"Economic burden of the persistent morbidity of nodding syndrome on caregivers in affected households in Northern Uganda","volume":"15","author":"Latio","year":"2020"},{"key":"b1","series-title":"eNeurologicalSci","first-page":"100401","article-title":"Nodding syndrome: A key role for sources of nutrition?","volume":"27","author":"Spencer","year":"2022"},{"key":"b2","series-title":"Trop Med Infect Dis","first-page":"211","article-title":"Nodding syndrome: A scoping review","volume":"6","author":"Abd-Elfarag","year":"2021"},{"key":"b3","series-title":"Int J Infect Dis","first-page":"112","article-title":"Is nodding syndrome an Onchocerca volvulus-induced neuroinflammatory disorder? 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